The Role of the Clinical Nurse Specialist in Cancer Care

Helen Kerr, PhD, RN, is a Senior Lecturer at the School of Nursing and Midwifery, Queen’s University Belfast. She has a clinical background in cancer and palliative care nursing.

List of Contributors xiv

Foreword xvi

Introduction xviii

About the Companion Website xxi

1 Evolvement of Advanced Nursing Practice 1
Helen Kerr

1.1 Introduction 1

1.2 Evolvement of Nursing as a Profession 1

1.3 Advanced Nursing Practice 3

1.3.1 Criteria Associated with Advanced Nursing Practice 4

1.3.2 Advanced Practice Nurse Roles 6

1.3.3 Regulation 8

1.3.4 Components of Advanced Practice Nurse Roles 8

1.3.5 Education Requirements 8

1.3.6 Outcomes Associated with Advanced Practice Nurse Roles 9

1.3.7 Barriers to Advanced Practice Nursing Roles 9

1.3.8 Recommendations for Advanced Practice Nurse Roles 10

1.4 Conclusion 10

References 11

2 Emergence and Evolvement of the Clinical Nurse Specialist Role in Cancer Care 15
Helen Kerr

2.1 Introduction 15

2.2 Advanced Nursing Practice 15

2.3 Historical Context 16

2.4 Specialists vs. Generalists 17

2.5 Definition of a CNS 18

2.5.1 Role Blurring 18

2.6 Components of the Clinical Nurse Specialist Role 19

2.6.1 Direct Patient Care 20

2.6.2 Indirect Care 20

2.7 Professional Standards 21

2.8 Education Requirements 22

2.8.1 Impact of a Master’s Qualification 22

2.9 Outcomes of the Clinical Nurse Specialist Role 23

2.9.1 Outcomes Associated with the Clinical Nurse Specialist in Cancer Services 24

2.10 Specialist Practice in Cancer Care 25

2.11 Future Direction of the CNS 25

2.12 Conclusion 25

References 26

3 Patient Perspective 31
Johanna McMullan

References 40

4 Carer’s Perspective 43
Trevor Wightman

5 Key Worker Role 49
Karen Armstrong and Helen Kerr

5.1 Introduction 49

5.2 The Key Worker 50

5.2.1 Provision of Information 52

5.2.2 Provision of Emotional and Supportive Care 52

5.2.3 Coordination of Services 53

5.3 Key Worker/Clinical Nurse Specialist Impact on Direct and Indirect Patient Care 54

5.4 Challenges in Practice 55

5.5 ‘First Impressions Count’ 57

5.6 Example of Change in Practice 58

5.7 Conclusion 59

References 59

6 Psychological Support 63
Caroline McCaughey, Edel Aughey, and Susan Smyth

6.1 Introduction 63

6.2 Part One: The Impact of a Cancer Diagnosis 64

6.2.1 Time Point One: Breaking Significant News 66

6.2.2 Time Point Two: Treatment Decision-Making 70

6.2.3 Time Point Three: Survivorship and Resilience 71

6.2.4 Fear of Recurrence 73

6.3 Part Two: Self-Care and the Clinical Nurse Specialist 74

6.4 Conclusion 77

References 78

7 Integrating Research and Evidence-Based Practice 84
Adrina O’Donnell, Ruth Boyd, and Clare McVeigh

7.1 Introduction 84

7.2 Evidence-Based Practice 85

7.3 Barriers to the Implementation of Evidence-Based Practice in the Clinical Setting 86

7.4 Role of Evidence-Based Practice in Caring for Patients with Cancer and Their Carers 87

7.5 Providing Evidence-Based Care as a Clinical Nurse Specialist 87

7.6 Clinical Application of Evidence-Based Practice by Clinical Nurse Specialists 88

7.7 Cancer Research and Clinical Trials 89

7.8 Cancer Clinical Trials, Research Nurses and the Role of the Clinical Nurse Specialist 91

7.9 The Role of the Clinical Nurse Specialist Along the Cancer Clinical Trial Patient Pathway 92

7.10 Conclusion 97

References 98

8 Symptom Management 104
Michelle Keenan and Helen Kerr

8.1 Introduction 104

8.2 Pain 105

8.2.1 Renal Impairment 107

8.2.2 Hepatic Impairment 108

8.2.3 Neuropathic Pain 109

8.3 Breathlessness 110

8.4 Nausea and Vomiting 112

8.5 Constipation 115

8.6 Conclusion 115

References 116

9 Multidisciplinary Teamworking 124
Hinal Patel and Oonagh McSorley

9.1 Introduction 124

9.2 The Multidisciplinary Team 125

9.2.1 Characteristics of an Effective Multidisciplinary Team 126

9.2.1.1 The Team 126

9.2.1.2 Multidisciplinary Meeting Organisational Logistics 128

9.2.1.3 Infrastructure for the Multidisciplinary Meeting 128

9.2.1.4 Person-Centred Clinical Decision-Making 128

9.2.1.5 Team Governance 129

9.3 The Role of the Clinical Nurse Specialist in Relation to the Multidisciplinary Team 129

9.3.1 Challenges of the Clinical Nurse Specialist Working in a Team 130

9.4 Conclusion 132

References 133

10 Leadership and the Clinical Nurse Specialist 136
Ruth Thompson and Monica Donovan

10.1 Introduction 136

10.2 Leadership 137

10.3 Self-Recognition of the Clinical Nurse Specialist as a Leader 137

10.4 Leadership in the Context of the Clinical Nurse Specialist 139

10.4.1 Clinical Leadership 140

10.4.1.1 Clinical Expertise and Coordination of Care 141

10.4.2 Professional Leadership 142

10.4.2.1 Enhancing Practice 143

10.4.2.2 Service Improvement and Innovation 143

10.4.2.3 Collaborative Working 144

10.5 Conclusion 144

References 144

11 Nurse-Led Clinics 149
Shelley Mooney and Helen Kerr

11.1 Introduction 149

11.2 Nurse-Led Care and the Launch of Nurse-Led Clinics in Healthcare 150

11.3 Components of a Nurse-Led Clinic 151

11.4 Introducing a Nurse-Led Clinic 152

11.5 Nursing Skills Required to Introduce and Establish a Nurse-Led Clinic 154

11.6 Approaches to Delivering a Nurse-Led Clinic 155

11.7 Patient Outcomes Related to Nurse-Led Clinics 156

11.8 Benefits of Nurse-Led Clinics for the Registered Nurse 157

11.9 Benefits of Nurse-Led Clinics for the Healthcare Organisation 157

11.10 Challenges to Implementing Nurse-Led Clinics 158

11.11 Nurse-Led Clinic Service Evaluation 159

11.12 Future of Nurse-Led Clinics 159

11.13 Reflection on the Role as a Uro-Oncology CNS Undertaking Nurse-Led Clinics 160

11.14 Conclusion 161

References 162

12 Non-Medical Prescribing 166
Laura Croan and Barry Quinn

12.1 Introduction 166

12.2 Background 167

12.3 Developments in Nursing Practice and the Role of Prescribing 168

12.3.1 Community Nurse Prescribing 168

12.3.2 Clinical Management Plans 169

12.3.3 Patient Group Directives 169

12.3.4 The Growth of Independent Prescribing 170

12.4 Preparing to Prescribe 172

12.5 Benefits and Challenges of Non-Medical Prescribing 172

12.6 Deciding to Become a Non-Medical Prescriber 173

12.7 Conclusion 177

References 178

13 Cancer in the Adolescent and Young Adult 181
Kerrie Sweeney and Helen Kerr

13.1 Introduction 181

13.2 Background to Adolescent and Young Adult Cancer Services 182

13.3 Person-Centred Adolescent and Young Adult Care 185

13.4 Support for Family and Significant Others 185

13.5 Holistic Care 186

13.6 Multidisciplinary Working 187

13.7 Healthcare Professional Knowledge 188

13.8 Adolescent and Young Adult Clinical Nurse Specialist Leadership Skills 189

13.9 Communication with Adolescents and Young Adults 189

13.10 Age-Appropriate Environments 191

13.11 Adolescent and Young Adult Peer Support 192

13.12 Adolescent and Young Adult Treatment Priorities 192

13.13 Transitional Adolescent and Young Adult Care 193

13.14 Living With and Beyond Cancer 194

13.15 Late Effects of Cancer Treatment 195

13.16 Palliative Adolescent and Young Adult Care 195

13.17 Co-production 196

13.18 Conclusion 196

References 197

14 COVID-19 and the Clinical Nurse Specialist 203
Stephanie Todd and Helen Kerr

14.1 Introduction 203

14.2 Impact on Healthcare Services and Frontline Healthcare Workers 204

14.3 Impact of COVID-19 on Cancer Services 205

14.4 The Role of the Clinical Nurse Specialist Prior to the COVID- 19 Pandemic 207

14.5 Devolvement of Staff over the COVID-19 Pandemic 208

14.6 Impact of COVID-19 on the Clinical Nurse Specialist Role and Patient Care 209

14.7 The Future of Healthcare Services Post–COVID-19 Pandemic 212

14.8 Conclusion 213

References 214

15 Digital Health 218
Amy Vercell and Sarah Hanbridge

15.1 Introduction 218

15.2 The Role of the Informatics Nurse/Chief Nursing Information Officer 220

15.3 Electronic Observations 220

15.4 Electronic Health Records 221

15.5 Digitalisation of Blood Glucose Monitoring 222

15.6 Electronic Nurse Prescribing 223

15.7 Nurse Digitally Requesting Bloods 224

15.8 Remote Consultations 224

15.9 Virtual Wards 225

15.10 Electronic Patient-Reported Outcome Measures 226

15.11 Mobile Cancer Applications 227

15.12 Home Blood Monitoring 228

15.13 Artificial Intelligence 229

15.14 Barriers to Digital Health 230

15.15 Conclusion 230

References 231

16 Future Direction of the Clinical Nurse Specialist in Cancer Care 236
Barry Quinn and Helen Kerr

16.1 Introduction 236

16.2 The Role of Caring and the Clinical Nurse Specialist 238

16.3 Developing Skills for Today and the Future 239

16.4 Leadership 240

16.5 Equality, Diversity and Inclusion in the Role of the Clinical Nurse Specialist 242

16.6 New Ways of Working 244

16.7 Self-Reflection 246

16.8 Conclusion 246

References 247

Index 250